Medicare Administrative Contractors (MACs)

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CMS must implement Medicare Contracting Reform by the year 2011. The law mandates that CMS conduct full and open competitions, in compliance with general federal contracting rules, for the work currently handled by fiscal intermediaries and carriers in administering the Medicare fee-for-service program. CMS hopes that Medicare contracting reform will integrate and simplify the administration of Medicare Parts A and B with primary Part A/Part B MACs which will process both Part A and Part B claims for the fee-for-service benefit. Prior to the transition, there were 23 FIs and 17 carriers. Under Medicare contracting reform, there will be 23 MACs with no national MAC. MACs will serve as the primary point of contact for provider enrollment, Medicare coverage and billing requirements training for providers, and the receipt, processing and payment of Medicare fee-for-service claims for Medicare providers’ respective jurisdictions. Medicare providers will be assigned to the local designated MAC based on their geographic location to the MAC which has jurisdiction for that benefit category and location.

AHCA/NCAL has provided some key documents that can help providers in each state to understand the responsibilities of MACs, check on the progress of the transition in their state, and help providers to prepare for the transition. Please view these documents here. Questions? Contact Elise Smith.